Table of Content

15 January 2022, Volume 25 Issue 02

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Editorial

Analysis of Non-pharmacological Management Strategies for Stable Chronic Obstructive Pulmonary Disease Based on 2021 GOLD's Global Strategy for the Diagnosis，Management，and Prevention of Chronic Obstructive Pulmonary Disease

LI Zhenghuan, ZHANG Xiaoyun, CHEN Yang, SONG Xueli, LIU Xin

2022, 25(02):  131-138.  DOI: 10.12114/j.issn.1007-9572.2021.01.310

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Chronic obstructive pulmonary disease (COPD) is now the third leading cause of death in the world, after ischemic heart disease and stroke. However, in the face of this preventable and curable major public health problem, there are still many problems in clinical diagnosis and treatment in China, such as insufficient health education, missing follow-up data, and non-standardized clinical management, which may be important causes of the deterioration of conditions, leading to increased difficulties in treating and higher possibility of poor outcome after late treatment as well as increased social and economic burden of COPD. Therefore, it is of great practical significance to accelerate the standardization of prevention, diagnosis and management of COPD to improve the accuracy and effectiveness of diagnosis and treatment of COPD. To provide a reference for emergency and respiratory clinicians to better treat COPD patients clinically, in view of domestic diagnosis, treatment and studies regarding COPD, we comprehensively analyzed the non-pharmacological treatment of stable COPD based on the updated GOLD's Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, mainly including pulmonary function measurement and assessment, smoking cessation, pulmonary rehabilitation, oxygen therapy, ventilatory support and surgical interventions.

Application of Biomarker Detection of Exhaled Air Condensate in Respiratory Diseases

XU Baichuan, LI Yiting, ZHAO Hulei, ZHANG Peng, XIE Yang

2022, 25(02):  139-144.  DOI: 10.12114/j.issn.1007-9572.2021.01.408

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Respiratory diseases are getting more and more attention, and their complex and changeable symptoms have brought a series of challenges to medical treatment. Many common clinical examination methods are not enough to comprehensively deal with the situation, and clinical examination methods are urgently needed to provide accurate and effective basis for diagnosis and treatment. The exhaled breath condensate (EBC) is a respiratory tract lining fluid obtained non-invasively, which is a new important source of biomarkers for respiratory diseases with high clinical research value. The EBC-based biomarker detection method can effectively reflect the changes in the patient's condition and optimize the treatment schedule. This method has received increasing clinical attention due to its advantages of simple operation, safety, non-invasiveness, high reproducibility, and good compliance. This article systematically analyzed the application status of biomarkers in EBC in the diagnosis, monitoring, efficacy evaluation and prognosis of respiratory diseases, and proposes corresponding problems in its collections, detection specifications and clinical applications, and provide a strong basis for its wide clinical application.

Article

Infection and Drug Resistance of Mycoplasma Pneumoniae: an Analysis of Influenza-like Illness

TU Peng, DOU Haiwei, SHI Dawei, WAN Ruijie, TIAN Xiujun, YUAN Qing, CHEN Xiaohua, XIN Deli

2022, 25(02):  145-148.  DOI: 10.12114/j.issn.1007-9572.2021.01.112

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Influenza and Mycoplasma pneumonia (MP) infection are common winter diseases in northern China, both of which have similar clinical symptoms. There are few studies on the infection of MP in individuals with influenza-like illness (ILI) .

To study the presence and drug resistance of MP in throat swabs from ILI patients.

Throat swab specimens of 915 outpatients with ILI were collected from 17 grade A tertiary healthcare institutions in 15 regions of China (Weifang, Kaifeng, Harbin, Inner Mongolia, Beijing, Tianjin, Tongchuan, Xianyang, Qinhuangdao, Dandong, Hanzhong, Taiyuan, Benxi, Luohe, Nanyang) during two winters (one was from December 2018 to February 2019, and the other from December 2019 to February 2020) . The Influenza A+B Antigen Test Kit (Colloidal Gold) was used to identify influenza viral antigens. PCR was used to detect the nucleic acid from pneumonia pathogens. DNA sequencing was used to detect the drug-resistant gene associated with MP.

Of the specimens, 578 were from children (<18 years) and 337 from adults (≥18 years) . The overall detection rate of influenza viral antigens was 45.25% (414/915) . The positive rate of influenza A was 91.06% (377/414) . Pediatric and adult cases had no statistical difference in the detection rate of influenza viral antigens〔44.29% (256/578) vs 46.88% (158/337) , χ²=0.577, P=0.447〕. The overall detection rate of MP was 11.91% (109/915) . Pediatric and adult cases had no statistical difference in the detection rate of MP〔4.34% (25/578) vs 24.93% (84/337) , χ²= 86.094, P<0.001〕. Of the MP-positive specimens, 74.31% (81/109) had A2063G mutations, 1.83% (2/109) had A2064G mutations, and 1.83% (2/109) had A2063G and A2064G mutations. In children's MP-positive specimens, 48.00% (12/25) had A2063G mutations, 8.00% (2/25) had A2064G mutations, and 8.00% (2/25) had A2063G and A2064G mutations, the other 36.00% (9/25) had drug-susceptible strains. Of the adult MP-positive specimens, 82.14% (69/84) had A2063G mutation, 17.86% (15/84) had drug-susceptible strains, and no A2064G mutation was found. The rate of presence of drug-resistant gene A2063G mutations in adult specimens was higher than that in pediatric specimens (χ²=11.765, P=0.001) . Both influenza viruses and MP were detected in 2.84% (26/915) of the specimens. The rate of co-presence of influenza viruses and MP in adult specimens was higher than that in pediatric specimens〔4.75% (16/337) vs 1.73% (10/578) , χ²=7.022, P=0.008〕.

During winters in 2018—2020, influenza A was the major type of influenza prevailing in northern China. MP infection was not rare in patients with ILI, and it was more common in adults than in children. The resistance rate of MP to macrolide antibiotics was relatively high. A2063G mutation in the 23SrRNA gene was the major type of mutations. Some cases were coinfected with influenza viruses and MP.

Development and Application Value Assessment of a Method for Measuring the Quality of Volume Calibration Syringes

WU Zhongping, HUANG Ruibo, ZHENG Jinping, GAO Yi

2022, 25(02):  149-152.  DOI: 10.12114/j.issn.1007-9572.2021.01.037

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Pulmonary examination is a measurement technique in medicine, and the quality of examination equipment is a key factor associated with the accuracy of examination results. Guidelines for mechanical lung function measurements have proposed that the spirometer should be calibrated each time it is used by the calibration cylinder for quality control, so the accuracy of the calibration cylinder will directly associate with that of the spirometer. However, there are no reports on the accuracy, and eligible standards, as well as calibration procedure regarding spirometer calibration cylinders measured by relevant research institutions (including calibration cylinder manufacturers) .

To develop a method, and use it to measure the performance of volume calibration cylinders commonly applied in China to assess its application value.

According to the standards for 3 L calibration syringe proposed in the Standardization of Spirometry 2019 Update issued by the American Thoracic Society (ATS) /European Respiratory Society (ERS) , the 1180 cylinder verifier (produced by Hans Rudolph, inc.) was used in the leak test and volume accuracy test for measuring the performance of five brands of imported/domestic calibration cylinders (Two were produced by Germany's CareFusion, and Vyaire, respectively, one by MGC Diagnostics, USA, and the other two by China's Zhejiang U-Breath, and Ningbo Wendi Medical Instrument CO, LTD, respectively) .

Of the five brands of calibration cylinders, 4/5 had less than 1 ml/min in the pressure attenuation leakage test, 4/5 had a volume error of less than 0.5% of the target volume, with an error range of less than 0.05% of the target volume, 3/5 passed both tests.

In this study, the method of directly measuring the change of gas volume of volume calibration cylinder is used for quality detection. The method is simple and feasible. It is recommended that the calibration cylinder should be regularly checked for assuring the accuracy.

TG/HDL-C Ratio and ba-PWV in Patients with Essential Hypertension

ZENG Rong, ZHENG Keyang, YAN Jiafu, WANG Zuoguang, CHENG Wenli

2022, 25(02):  153-158.  DOI: 10.12114/j.issn.1007-9572.2021.01.223

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Dyslipidemia is a major risk factor for cardiovascular disease. Triglyceride /high-density lipoprotein cholesterol (TG/HDL-C) ratio has been proved to be more effective in predicting cardiovascular events than a blood lipid index or low-density lipoprotein cholesterol (LDL-C) /HDL-C ratio. There are few clinical studies about TG/HDL-C ratio assessing arterial stiffness in hypertensive populations. Moreover, studies on the characteristics of ambulatory blood pressure parameters by TG/HDL-C ratio are also rare.

To explore the association of fasting TG/HDL-C ratio with brachial-ankle pulse wave velocity (ba-PWV) in essential hypertensive patients based on analyzing these patients' clinical features, ambulatory blood pressure and ba-PWV.

A total of 439 essential hypertension patients (aged 18-80 years) were recruited from Hypertension Department, Beijing Anzhen Hospital, Capital Medical University from August 2014 to December 2015. Data were collected, including sex, age and medical history (diabetes history, hyperlipidemia history, smoking status, drinking status) , height, weight, BMI, serum creatinine, total cholesterol, TG, LDL-C, HDL-C, serum uric acid, fasting blood glucose, calculated TG/HDL-C ratio, 24 h ambulatory blood pressure parameters〔mean systolic blood pressure (SBP) , diastolic blood pressure (DBP) and heart rate in 24 h, in the daytime and at the nighttime, prevalence of nocturnal fall in SBP and DBP, and dipper blood pressure pattern〕 during hospitalization, and mean heart rate. Arterial stiffness was assessed by ba-PWV. The above-mentioned indicators were compared between lower (n=219) and higher quantile groups (n=220) divided by TG/HDL-C ratio. The influencing factors of ba-PWV were investigated by multiple linear regression analysis.

(1) Higher quantile group had higher male proportion, higher prevalence of hyperlipidemia and smokers, higher mean BMI, serum creatinine, total cholesterol, TG, serum uric acid, and fasting blood glucose, as well as lower men age, and HDL-C than lower quantile group (P<0.05) . (2) Higher quantile group had higher mean 24-hour SBP and DBP, daytime SBP and DBP, nighttime SBP and DBP, nighttime heart rate and ba-PWV, and lower prevalence of nocturnal fall in SBP and DBP, and dippers than lower quantile group (P<0.05) . (3) Multiple linear regression analysis showed that, age〔β=12.35, 95%CI (10.307, 14.401) 〕, fasting blood glucose〔β=20.69, 95%CI (1.532, 39.854) 〕, TG/HDL-C ratio〔β=20.99, 95%CI (6.176, 35.810) 〕 and 24 hour mean SBP〔β=7.57, 95%CI (5.656, 9.493) 〕 were associated with ba-PWV (P<0.05) .

In essential hypertension patients, elevated 24-hour SBP and DBP were found in those with higher TG/HDL-C ratio, and TG/HDL-C ratio may be independently associated with ba-PWV. Monitoring TG/HDL-C ratio helps early detection of arteriosclerosis and elevated blood pressure, promoting comprehensive management of cardiovascular risk factors.

Application of Scatter Diagram in Prehospital Screening for Arrhythmia Using Single Lead，Wearable Remote ECG Monitoring System

YU Xinyan, ZHAO Ruiqin, PENG Jun, ZHANG Xiaojuan, YANG Jianyun, ZHANG Haicheng

2022, 25(02):  159-165.  DOI: 10.12114/j.issn.1007-9572.2021.01.405

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Arrhythmia is a common cardiovascular disease, which has a range of transient or paroxysmal conditions. Arrhythmia easily occurs outside of the hospital, but signals of its onset often could not be captured by traditional ECG devices since they can not be worn at any time.

To assess the effect of applying scatter diagram in prehospital screening for arrhythmia via analyzing patients' data monitored by the single lead, wearable remote ECG monitoring system.

Participants (n=1 076) were primary care patients who were selected from Yinchuan from September 2018 to September 2019. All of them used single lead, wearable remote ECG monitoring system to monitor cardiac rhythms prehospitally when they had palpitation, dizziness, chest tightness, shortness of breath and other symptoms, and real-timely uploaded 24-hour ambulatory ECG data to be used for screen for arrhythmia by different approaches: approach A (diagnosis made using scatter diagram analysis by primary care physicians) , approach B (diagnosis made using scatter diagram analysis by physicians from Remote ECG Center, the First People's Hospital of Yinchuan) , and approach C (diagnosis made using scatter diagram analysis and ECG analysis by physicians from Remote ECG Center, the First People's Hospital of Yinchuan) . Prevalence and types of arrhythmia detected by these approaches and diagnostic coincidence rate of these approaches were analyzed. The sensitivity, specificity, positive and negative predictive values of approaches A and B were assessed with those of approach C as the gold standard.

(1) The frequencies of arrhythmias detected by approaches A, B and C were 1 301, 1 323, and 1 647, respectively. The types of arrhythmias detected by approaches A, B and C were 14, 14, and 15, respectively. And the prevalence of arrhythmias detected by approaches A, B and C were 80.9%, 81.2% and 87.5%, respectively. (2) The diagnoses made by approaches A and B were highly consistent〔Kappa=0.891, 95%CI (0. 711, 1.071) , P=0.617〕, and the diagnostic coincidence rate was 96.7%. The diagnoses made by approaches B and C were highly consistent〔Kappa=0.759, 95%CI (0.489, 1.029) , P<0.001〕, and the diagnostic coincidence rate was 93.6%. The diagnoses made by approach A were relatively consistent with those by approach C〔Kappa=0.692, 95%CI (0.392, 0.992) , P<0.001〕, and the diagnostic coincidence rate was 91.7%. (3) The sensitivity, specificity, positive and negative predictive values of approach A in diagnosing arrhythmia were 91.5%, 93.3%, 99.0% and 61.2%, and those of approach B were 92.8%, 99.3%, 99.9% and 66.3%.

Using scatter diagram in prehospital screening for arrhythmia through analyzing the monitoring results of single lead, wearable remote ECG monitoring system will contribute to the development of arrhythmia diagnosis and treatment in primary care, and the establishment of an arrhythmia prevention and treatment network with the participation of residents, primary care physicians and remote ECG center physicians.

Study on the Correlation between Blood Glucose Level and Hospital Mortality in Acute Aortic Dissection Patients

ZHAO Junjian, WANG Hongyan, ZHAO Yongbo, Liu Xiao, XIONG Yanjie, ZHANG Jinjin, SU Peng, MA Dong

2022, 25(02):  166-170.  DOI: 10.12114/j.issn.1007-9572.2021.01.113

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Acute aortic dissection (AAD) is more common in critically ill patients, and hyperglycemia is an adverse factor affecting the mortality of critically ill patients.

To investigate the correlation between admission blood glucose level and in-hospital mortality in patients with AAD.

A retrospective analysis of the case data of non-diabetic AAD patients who underwent surgical treatment at the Fourth Hospital of Hebei Medical University from January 2015 to August 2020. According to admission blood glucose level, all cases were divided into: the hyperglycemia group (>7.8 mmol/L) and the normal blood glucose group (≤7.8 mmol/L) ; Cox proportional hazard modelwas used to evaluate the correlation between admission blood glucose and in-hospital mortality in AAD patients; Kaplan-Meier method was used to analyze the survival curve; ROC analysis was conducted to evaluate the predicting values of admission blood glucose for the in-hospital mortality in AAD patients; Cox regression model were performed to determine influencing factors for in-hospital mortality in AAD patients.

A total of 491 AAD patients were collected including 165 (33.6%) cases in the hyperglycemia group and 326 (66.4%) cases in the normal blood glucose group. Compared to the normal glucose group, higher in-hospital mortality was found in the hyperglycemia group (19.4% vs 10.4%, χ²=4.172, P=0.006) ; In the unadjusted Cox model, the relative risk of death in the hyperglycemia group was 1.943〔95%CI (1.199, 3.150) , P=0.007〕; After adjusting for age and sex in moderately adjusted model, it was 1.900〔95%CI (1.171, 3.082) , P=0.009〕 in the hyperglycemia group compared with the normal blood glucose group; After adjusting for age, gender, hypertension, coronary heart disease, smoking, Stanford type, systolic blood pressure and diastolic blood pressure, the risk of in-hospital death in the hyperglycemia group was 1.840〔95%CI (1.124, 3.010) , P=0.015〕. The area under the ROC curve of admission blood glucose for predicting in-hospital death of AAD patients is 0.612 (0.546, 0.696) , when the admission blood glucose cut-off value was 9.4 mmol/L, the sensitivity was 37.9% and the specificity was 84.9%, respectively. The results of multivariate Cox regression model analysis showed that Stanford type A〔HR=4.277, 95%CI (1.942, 9.420) , P<0.001〕 and blood glucose〔HR=1.864, 95%CI (1.617, 2.113) , P=0.007〕 were the influencing factors for in-hospital death in AAD patients.

The admission blood glucose level is an influencing factor for the in-hospital mortality in AAD patients, and high blood glucose level may increase the risk of in-hospital mortality in AAD patients.

Geographic Variability of Upper Urinary Tract Stone Constituents in Hebei Adults

CHANG Xueliang, WANG Yaxuan, LI Jingdong, ZHANG Yanping, TENG Zhihai, HAN Zhenwei

2022, 25(02):  171-174.  DOI: 10.12114/j.issn.1007-9572.2021.01.601

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Urinary stones are a common and frequently-occurring disease of the urinary system, among which upper urinary tract stones are the most common, imposing a heavy burden on patients. The causes of upper urinary tract stones are complex, which are closely associated with gender, age, geographic condition, climate, diet, and so on. However, it is still unclear whether upper urinary stone constituents vary by geographical conditions.

To analyze the constituents of upper urinary tract stones among adults in different geographic regions of Hebei, providing evidence for clinical treatment and prevention of upper urinary tract stones.

Outpatients and inpatients (n=1 192, ≥18 years old) with upper urinary calculis who were from three geographical regions (mountainous, plain and coastal) of Hebei were selected from the Second Hospital of Hebei Medical University in 2019. Upper urinary tract stones of the outpatients removed by extracorporeal shock wave lithotripsy, and those of the inpatients removed by surgery were collected for quantitative and qualitative constituent analyses by geographical region using infrared spectrometry.

Upper urinary tract stones were more often found in those 30 to 70 years old, with a male to female ratio about 1.75∶1. Kidney stones and ureteral stones accounted for similar proportions (about 1.1∶1) , and the mixed stones were more common (61.5%) . Calcium-containing stones were the major type of upper urinary tract stones in participants from each geographic regions, with calcium oxalate monohydrate being the most. The prevalence of infectious stones showed no significant differences across participants from three regions (P>0.05) . The prevalence of uric acid-containing stones in participants from plain was significantly different from that of participants from mountainous or coastal region (P<0.05) .

Calcium-containing stones were the most common prevalent in upper urinary tract stones patients across three geographic regions of Hebei, and the prevalence of uric acid-containing stones in those from mountainous or coastal region was higher, which require the attention of urologists.

Article·Sleep-related Breathing Disorders

A Study on the Diurnal Variation of Ventricular Repolarization Parameters in Patients with Obstructive Sleep Apnea

YANG Beibei, JIANG Junguang, SHI Jiang, ZHANG Yang

2022, 25(02):  175-179.  DOI: 10.12114/j.issn.1007-9572.2021.01.406

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Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common sleep breathing disorder. More and more studies have shown that OSAHS has a significant correlation with cardiovascular disease. It is an independent risk factor for arrhythmia, hypertension, coronary heart disease and other cardiovascular diseases, but the specific mechanism is still not completely clear. Relevant evidence indicates that ventricular repolarization parameters such as Tp-e interval, QT interval and Tp-e/QT ratio may be related to arrhythmia and even sudden cardiac death. However, up to now, there are relatively few studies on OSAHS-related arrhythmias and changes in cardiac electrical parameters.

To study the diurnal variation of ventricular repolarization parameters in patients with obstructive sleep apnea.

A total of 159 OSAHS patients who met the inclusion criteria and received polysomnography monitoring in the First Affiliated Hospital of Zhengzhou University from June 2020 to July 2021 were selected as the observation group, further divided into mild-moderate OSAHS group (n=78) and severe OSAHS group (n=81) according to the severity. Fifty-one healthy people without disease were selected as the control group. Daytime and nocturnal Tp-e interval, QT interval, Tp-e/QT ratio were measured and calculated for all participants.

There were significant differences in daytime Tp-e interval, nocturnal Tp-e interval, daytime Tp-e/QT ratio, nocturnal Tp-e/QT ratio among the control group、the mild-moderate OSAHS group and the severe OSAHS group (P<0.001) . In addition, the daytime Tp-e interval, nocturnal Tp-e interval, daytime Tp-e/QT ratio and nocturnal Tp-e/QT ratio have a gradually increasing trend among the three groups (P<0.05) . There were no significant differences in daytime QT interval and nocturnal QT interval among the three groups (P>0.05) .Tp-e interval, QT interval, Tp-e/QT ratiosin the observation group were statistically different between daytime resting state and nocturnal obstructive state (P<0.05) ; The Tp-e interval, QT interval, and Tp-e/QT ratio in nocturnal obstructive state were significantly longer than those in daytime resting state (P<0.05) .The nocturnal Tp-e interval (r_s=0.221, P=0.005) and nocturnal Tp-e /QT (r_s=0.298, P<0.001) of OSAHS patients were positively correlated with AHI.

Ventricular repolarization parameters in OSAHS patients during nocturnal obstructive apnea are longer than those in daytime resting state, and the diurnal variation is significant, which provides a new idea for the future study of OSAHS with arrhythmia.

Characteristics of Attention Deficit and Hyperactivity Disorder in Children with Sleep-disordered Breathing

WU Yunxiao, WAN Zhen, KONG Fanying, XU Zhifei

2022, 25(02):  180-184.  DOI: 10.12114/j.issn.1007-9572.2021.01.036

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Children with sleep-disordered breathing (SDB) are more prone to attention deficit, and hyperactivity disorder, which seriously impairs their learning ability and long-term intellectual development. However, there is a lack of comprehensive analysis of attention deficit, and hyperactivity disorder in SDB children.

To investigate the characteristics of attention deficit, and hyperactivity disorder in children with SDB, so as to provide a basis for making clinical decisions for such patients.

Children aged 4-10 years with snoring or mouth breathing, who were admitted to the Sleep Center, Beijing Children's Hospital, Capital Medical University from May 2020 to June 2021 were selected. Physiologic parameters during sleep were measured by polysomnography. Attention deficit and hyperactivity disorder symptoms were assessed by parent-rated attention deficit and hyperactivity disorder Symptoms Scale (PASS) . The severity of obstructive sleep apnea (OSA) was classified by obstructive apnea-hypopnea index (OAHI) : OAHI≤1 event/hour, 1<OAHI≤5 events/hour and OAHI>5 events/hour were defined as primary snoring, mild OSA, and moderate to severe OSA, respectively. Polysomnographic parameters〔total sleep time, sleep efficiency, non-rapid eye movement (NREM) sleep stage 1 (N1%) , stage 2 (N2%) , and stage 3 (N3%) and REM sleep percentage of total sleep time (R%) , OAHI, arousal index (ArI) , oxygen desaturation index (ODI) , average oxygen saturation (SpO₂) and SpO₂ nadir〕 were compared by the severity of OSA. The prevalence of attention deficit, hyperactivity disorder, and attention deficit and hyperactivity disorder diagnosed by the PASS were compared by the severity of OSA, sex and age.

Seventy-six cases of primary snoring, 86 cases of mild OSA and 77 cases of moderate to severe OSA were included. Moderate to severe OSA children had greater N1%, OAHI, ArI, and ODI, and lower average SpO₂ and SpO₂ nadir than other two groups (P<0.05) . The R% of moderate to severe OSA group was lower than that of primary snoring group (P< 0.05) . OAHI, ArI and ODI were higher and SpO₂ nadir was lower in children with mild OSA than those with primary snoring (P<0.05) . The prevalence of attention deficit, and attention deficit and hyperactivity disorder diagnosed by the PASS in moderate to severe OSA group was statistically higher than that in primary snoring group (P '<0.016 7) . Male children had higher prevalence of attention deficit, hyperactivity disorder, and attention deficit and hyperactivity disorder diagnosed by the PASS than female children (P<0.05) . Compared with preschoolers, school-age children have higher prevalence of attention deficit and attention deficit and hyperactivity disorder diagnosed by the PASS (P<0.05) .

The prevalence of attention deficit and hyperactivity disorder in children with SDB was higher than that in the general population. Male children had higher prevalence of attention deficit and hyperactivity disorder than female children. And the prevalence of attention deficit in school-age children was higher than that in preschoolers.

The Value of Abdominal Visceral Adipose Tissue Area and Homeostasis Model Assessment of Insulin Resistance in Predicting Essential Hypertension Complicated with Obstructive Sleep Apnea Syndrome

GAN Lulu, HE Yan, LIU Shijie, NI Qing, YANG Li

2022, 25(02):  185-188.  DOI: 10.12114/j.issn.1007-9572.2021.01.040

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The prevalence of essential hypertension complicated with obstructive sleep apnea hypopnea syndrome (OSAHS) has been increasing year by year. However, due to the differences in medical conditions and lack of clinical understanding in different regions of China, the diagnosis of hypertension complicated with OSAHS is still insufficient. Relevant studies have shown that the pathogenesis of hypertension complicated with OSAHS is closely related to the ectopic accumulation of fat and insulin resistance.

This study attempted to analyze the relationship between OSAHS and abdominal visceral adipose tissue (VAT) and homeostasis model assessment of insulin resistance (HOMA-IR) , and their predictive value for hypertension complicated with OSAHS.

Two hundred and thirty-four patients with essential hypertension treated at hypertension center of Yan'an Hospital of Kunming Medical University from January 2019 to July 2020 were enrolled in the study. The HOMA-IR of the enrolled patients was calculated by polysomnography, VAT measurement, parallel glucose tolerance and insulin release experiments. According to the AHI level, 27 patients were divided into hypertension group (AHI<5 times/h) , and 207 patients were divided into hypertension complicated with OSAHS group (AHI≥5 times/h) . The levels of VAT and HOMA-IR were compared between 2 groups. The receiver operating characteristic (ROC) curve of screening hypertension patients complicated with OSAHS were determined by HOMA-IR and VAT, and the diagnosis value of area under AUC and different cut-off value were calculated. Logistic regression modeling was used to determine ROC curve with the saved probability as a separate variable to analyze the AUC of the two combined diagnosis of hypertension and OSAHS.

The VAT, HOMA-IR and BMI of hypertension complicated with OSAHS group were significantly higher than the hypertension group, while LSaO₂ was significantly lower than the hypertension group. VAT, HOMA-IR and BMI were positively correlated with AHI (P<0.05) , and LSaO₂ was negatively correlated with AHI (P<0.05) . The AUC of ROC curve for the diagnosis of hypertension complicated with OSAHS by VAT was 0.905 〔95%CI (0.861, 0.949) 〕, and the sensitivity and specificity were 0.763 and 0.926 when the diagnostic cut-off point was 100.5 cm². The ROC curve AUC of HOMA-IR in the diagnosis of hypertension complicated with OSAHS was 0.813 〔95%CI (0.725, 0.900) 〕, when the diagnostic cut-off point was 2.015, the sensitivity and specificity were 0.797 and 0.778, respectively, and the AUC of ROC curve for combined factor diagnosis of hypertension complicated with OSAHS was 0.917 〔95%CI (0.871, 0.963) 〕, the diagnostic cut-off point was 2.045, the sensitivity and specificity were 0.831 and 0.963, respectively.

VAT and HOMA-IR in hypertension patients complicated with OSAHS are significantly higher than those in patients with hypertension. VAT and HOMA-IR have a certain predictive value for hypertension complicated with OSAHS, and can be applied to medical institutions that unconditionally carry out polysomnography, in order to intervene as early as possible to reduce the risk of serious complications of cardiovascular and cerebrovascular diseases.

Article·Chronic Obstructive Pulmonary Disease

Correlation of Malnutrition，25-hydroxy Vitamin D and Interleukin-1β with Chronic Obstructive Pulmonary Disease in Elderly Inpatients

DAI Jingrong, LI Jie, HE Xu, LI Yang, LI Yan

2022, 25(02):  189-196.  DOI: 10.12114/j.issn.1007-9572.2021.01.503

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The specific pathogenesis of chronic obstructive pulmonary disease (COPD) is still not very clear so far, clinical interventions mainly focus on the control of pulmonary symptoms with drugs, however, the influence of extrapulmonary related factors of COPD has not caused enough attention.

To explore the correlation of malnutrition, 25-hydroxy vitamin D and interleukin-1β with COPD in elderly inpatients.

A total of 305 inpatients (≥60 years old) were recruited from Department of Geriatrics, the First People's Hospital of Yunnan Province from November 2020 to August 2021, and divided into COPD group (n=89) and non-COPD group (n=216) according to the incidence of COPD. General information and comprehensive geriatric assessment results were compared between the two groups; binary Logistic regression analysis was used to analyze the influencing factors of COPD in elderly inpatients, and Spearman rank correlation analysis was used to analyze the correlation of malnutrition, 25-hydroxy vitamin D and interleukin-1β with COPD.

There were significant differences in age, gender, current smoking rate, nutritional status, cognitive function, incidence of anxiety and depression, incidence of disability, sleeping status, frailty status, proportion of multiple drugs, kinds of drugs used, platelet count, C-reactive protein, total protein, albumin, thyroxine, 25-hydroxy vitamin D, estradiol, testosterone, prothrombin time, D-dimer, interleukin-6 and interleukin-1β between the two groups (P<0.05) . The results of binary Logistic regression analysis showed that, current smoking〔OR=2.351, 95%CI (1.053, 5.249) 〕, underlying malnutrition〔OR=2.429, 95%CI (1.118, 5.276) 〕, malnutrition〔OR=3.936, 95%CI (1.355, 11.439) 〕, sleeplessness〔OR=2.584, 95%CI (1.094, 6.102) 〕, C-reactive protein〔OR=0.988, 95%CI (0.978, 0.999) 〕, 25-hydroxy vitamin D〔OR=0.929, 95%CI (0.880, 0.981) 〕and interleukin-1β〔OR=1.025, 95%CI (1.003, 1.047) 〕were independent influencing factors of COPD in elderly inpatients (P<0.05) . The results of Spearman rank correlation analysis showed that, malnutrition (r_s=0.280, P<0.001) and interleukin-1β (r_s=0.145, P=0.011) were positively correlated with the incidence of COPD in elderly inpatients, while 25-hydroxy vitamin D was negatively correlated with the incidence of COPD (r_s=-0.264, P<0.001) .

Malnutrition, 25-hydroxy vitamin D and interleukin-1β are independent influencing factors of COPD in elderly inpatients. Among them, malnutrition and interleukin-1β are positively correlated with the incidence of COPD, while 25-hydroxy vitamin D is negatively correlated with the incidence of COPD.

Effect of Integrated Chinese and Western Medicine Treatment on Immune Factors in a Rat Model with Phlegm-heat Syndrome in Acute Exacerbation-stable Stage of Chronic Obstructive Pulmonary Disease

LI Xiaojun, LI Ya, BIAN Qingqing, XUAN Yinshuang, SHEN Tingting, LI Suyun

2022, 25(02):  197-205.  DOI: 10.12114/j.issn.1007-9572.2021.01.044

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Secretory immunoglobulin A (sIgA) deficiency and immune imbalance caused by T lymphocyte aggregation in lung tissue are associated with the development of chronic obstructive pulmonary disease (COPD) . Human gastrointestinal and respiratory tracts have a typical mucosal structure, which are connected with the common mucosal immune system.

To examine the responses of some immune factors to integrated Chinese and Western Medicine treatment in a rat model with phlegm-heat syndrome during the acute exacerbation to stable stage of COPD.

A study was implemented between September 2019 and December 2020. Sixty SPF Sprague-Dawley rats were selected, and divided into five groups using the RAND function in Excel: control, COPD, acute exacerbation of COPD (AECOPD) , Western Medicine, and integrated Chinese and Western Medicine. Except the control group, other groups were exposed to cigarette smoke and heat, and received intranasal administration of lipopolysaccharide to develop COPD in acute exacerbation to stable stage with phlegm-heat syndrome. The intervention in the acute exacerbation stage lasted for 8 days, during which Western Medicine group received intragastric administration of solution containing moxifloxacin hydrochloride tablets (0.027 g·kg^-1·d^-1) and salbutamol sulfate tablets (0.41 mg·kg^-1·d^-1) , integrated Chinese and Western Medicine group received intragastric administration of solution containing Tongsai granules (7.2 g·kg^-1·d^-1) , moxifloxacin hydrochloride tablets (0.027 g·kg^-1·d^-1) , and salbutamol sulfate tablets (0.41 mg·kg^-1·d^-1) , the other three groups received intragastric administration of isotonic (0.9%) sodium chloride 2 ml per day. Subsequently, the intervention in the stable period lasted for 14 days, during which western medicine group received intragastric administration of salbutamol sulfate tablets 0.41 mg·kg^-1·d^-1, and the integrated Chinese and Western Medicine group received intragastric administration of BufeiYishen formula 4.42 g·kg^-1·d^-1 and salbutamol sulfate tablets 0.41 mg·kg^-1·d^-1. The other three groups received intragastric administration of isotonic (0.9%) sodium chloride 2 ml per day. The forced vital capacity (FVC) , forced expiratory volume during the first 300 milliseconds (FEV_0.3) , FEV_0.3/FVC ratio, and sIgA, as well as CD₃⁺ and CD₄⁺, in the lung and gut were detected after the interventions.

The FVC, FEV_0.3, FEV_0.3/FVC ratio, sIgA in the lung and gut, as well as expression level of CD₃⁺ in the lung, showed a trend of successive decrease across control group, COPD group, and AECOPD group (P<0.05) . The above-mentioned parameters were lower in AECOPD group than those of Western Medicine group or integrated Chinese and Western Medicine group (P<0.05) . And they were lower in Western Medicine group than those of integrated Chinese and Western Medicine group (P<0.05) .

Integrated Chinese and Western Medicine treatment may improve immunity of the rat model via repairing the immune barrier function of the lung and gut by increasing the expression of sIgA, CD₃⁺, and CD₄⁺ in the lung and gut, which provides evidence for the prevention and treatment of COPD with Chinese medicine.

The Value of Handheld COPD-6 Spirometry for Early COPD Detection in High Risk Elderly Population in Community

XU Yunli, SHAO Hongtao, REN Xiaohong, LIU Lilan

2022, 25(02):  206-211.  DOI: 10.12114/j.issn.1007-9572.2021.01.315

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Chronic obstructive pulmonary disease (COPD) is a common chronic disease of the respiratory tract, and lung function is necessary for the diagnosis of COPD. However, conventional pulmonary function meters are not suitable for a large number of physical examinations in the community. In recent years, it is recommended to use spirometry for COPD screening and management both at home and abroad. However, there is still a lack of relevant data on its consistency and effectiveness with conventional lung function.

To explore the value of handheld COPD-6 spirometry for early COPD detection in high risk elderly population in community.

From January 2018 to December 2019 at Dongshan Community Health Service Center, Jiangning District, Nanjing City, a free physical examination was performed on the elder population over 60 years who had high risk factors of COPD. Handheld COPD-6 spirometry was performed pre- and post-bronchodilator, the forced expiratory volume in one second (FEV₁) , the forced expiratory volume in one second as a percentage of the predicted value (FEV₁%prep) , the forced expiratory volume in six second (FEV₆) , the percentage of forced expiratory volume in six second to the predicted value (FEV₆%prep) , and the value of FEV₁/FEV₆ were evaluated and recorded. With FEV₁/FEV₆<80% as the initial screening positive pre-bronchodilator, retests were performed both with handheld COPD-6 spirometry and confirmatory spirometry after inhaling bronchodilator. Using FEV₁/Forced vital capacity (FVC) <70% as the gold standard by confirmatory spirometry, receiver-operator characteristic (ROC) curve analysis was used to obtain the best diagnostic threshold of FEV₁/FEV₆. Sensitivity, specificity, positive predictive value, and negative predictive value were used to evaluate the diagnostic value of the handheld COPD-6 spirometer.

Out of the 382 participants, COPD was confirmed in 75 according to FEV₁/FVC<70% post-bronchodilator. There was no statistically significant difference between FEV₁%pred pre- and post-bronchodilator by handheld COPD-6 spirometry (t=-0.971, P=0.703) ; There was no statistically significant difference among FEV₁%pred in two tests (t=-2.352, -1.429; P=0.396, 0.058) . The FEV₁%pred detected by handheld COPD-6 spirometry post-bronchodilation was positively correlated with confirmatory spirometry (r=0.969, P<0.05) . Compared with FVC%pred and FEV₆%pred post-bronchodilation, the difference was statistically significant (t=-3.170, P=0.005) ; and the FEV₆%pred was positively correlated with the FVC%pred (r=0.653, P<0.05) . There was no statistically significant difference between FEV₁/FEV₆ and FEV₁/FVC post-bronchodilation (t=1.735, P=0.084) ; and there was substantial agreement between the two diagnostic (r=0.871, P<0.05) . The FEV₁/FEV₆ cut-off with the greatest sum of sensitivity and specificity was 71% pre-bronchodilator, the sensitivity, specificity, positive and negative predictive values were 80.0%, 79.2%, 90.6% and 48.5% respectively. The greatest sum of sensitivity and specificity was 75% post-bronchodilator, the sensitivity, specificity, positive and negative predictive values were 80.0%, 98.8%, 98.4% and 58.3% respectively.

It is feasible to use FEV₁/FEV₆ as an indicator to screen COPD patients in elderly high-risk populations. It is recommended to use FEV₁/FEV₆<71% before bronchodilation and FEV₁/FEV₆<75% after diastole as the screening criteria.

Prediction Methods of Exercise Induced Desaturation Detected by Six-minute Walk Test in Patients with Stable Chronic Obstructive Pulmonary Disease

YANG Lulu, QUMU Shiwei , SITU Xuanming, HE Jiaze, YANG Ting

2022, 25(02):  212-216.  DOI: 10.12114/j.issn.1007-9572.2021.01.038

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Exercise-induced desaturation (EID) is highly prevalent, and associated with the prognosis in patients with chronic obstructive pulmonary disease (COPD) . Current predicators of EID mostly depend on pulmonary function, and the assessment for their values is different.

To explore simple, and accurate methods suitably used in primary care to predict EID by six-minute walk test (6MWT) in patients with stable COPD.

A retrospective study was conducted. Participants were 67 stable COPD patients with respiratory clinic follow-ups selected from China-Japan Friendship Hospital from 2019 to 2020. Data were collected, including assessment results of pulmonary function test, 6MWT, modified Medical Research Council (mMRC) , and COPD Assessment Test (CAT) , as well as calculated BODE index. EID in 6MWT was defined as the difference between minimum oxygen saturation in 6MWT and resting oxygen saturation at the beginning of 6MWT (ΔSpO₂) ≥4%. mMRC score, CAT score and BODE index were compared between patients with and without EID in 6MWT to estimate the association of ΔSpO₂ in 6MWT with mMRC score, CAT score and BODE index. ROC analysis was used to estimate the predictive value of mMRC score, CAT score and BODE index for inducible hypoxia in 6MWT.

The ΔSpO₂ in 6MWT was significantly negatively correlated with mMRC score (r=-0.492, P<0.001) , CAT score (r=-0.447, P<0.001) , and BODE index (r=-0.415, P<0.001) . The AUC of mMRC score in predicting EID in 6MWT was 0.683 (with 2 as the optimal cut-off value) , and that for CAT score was 0.765 (with 14 as the optimal cut-off value) , for BODE index was 0.711 (with 2 as the optimal cut-off value) .

All of mMRC score, CAT score and BODE index can be used to predict EID in 6MWT in patients with stable COPD.

Using Machine Learning to Build an Early Warning Model for the Risk of Severe Airflow Limitation in Patients with Chronic Obstructive Pulmonary Disease

ZHOU Lijuan, WEN Xianxiu, LYU Qin, JIANG Rong, WU Xingwei, ZHOU Huangyuan, XIANG Chao

2022, 25(02):  217-226.  DOI: 10.12114/j.issn.1007-9572.2021.01.313

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The degree of airflow limitation is a key indicator of the progression degree in COPD patients. However, problems such as contraindications to testing and compliance make it difficult for some patients to undergo the relevant tests and evaluate the severity of the disease.

To develop and evaluate a machine learning algorithm-based early warning model for the risk of severe airflow limitation in COPD patients.

A cross-sectional design was used to investigate COPD inpatients in a tertiary hospital in Sichuan Province from 2019-01 to 2020-06. General clinical indexes and pulmonary function test data were collected. The data were randomly divided into training and test sets in the ratio of 8∶2, and 216 risk warning models were constructed in the training set using four missing value filling methods, three feature screening methods, 17 machine learning and one integrated learning algorithm. The area under the ROC curve (AUC) , accuracy, precision, recall and F1 score were used to evaluate the predictive performance of the model; and the ten-fold cross-validation method and Bootstrapping were used for internal and external validation, respectively. The test set data was used for model testing and selection, the posterior method was used for sample size verification.

A total of 418 patients were included, of which 212 (50.7%) patients were at risk of severe airflow limitation. After four missing value treatments and three feature filters, a total of 12 processed datasets and the importance ranking of 12 factors affecting airflow limitation were obtained, and the results showed that modified medical research council dyspnea scale grade (mMRC) , age, body mass index (BMI) , smoking history (yes, no) , chronic obstructive pulmonary disease assessment test (CAT) score, and dyspnea (yes, no) were at the forefront inthe ranking of variable features and were key indicators for constructing the model, which had an important role in predicting the outcome. Using unfilled, Lasso screening, mMRC grade, smoking history (yes, no) , and dyspnea (yes, no) were the top 3 predictors, with mMRC grade accounting for 54.15% of feature importance. In which, using unfilled, Boruta screening, CAT score, age, and mMRC class were the top 3 predictors, and CAT score accounted for 26.64% of feature importance. A total of 216 prediction models were obtained using 17 machine learning algorithms and 1 integrated learning for each of the 12 datasets. 17 machine learning algorithms with 10-fold cross-validation showed that the differences were statistically significant (P<0.05) when comparing the prediction performance of different algorithms, and the average AUC of the stochastic gradient descent algorithm was maximum (0.738±0.089) . The results of external validation of the test set using the Bootstrapping algorithm showed that the differences were statistically significant (P<0.05) when comparing the prediction performance of the models obtained by different algorithms, and the average AUC of the integrated learning algorithm was maximum (0.757±0.057) . Evaluation of the prediction performance of four missing value treatments and three feature filters using the Bootstrapping algorithm showed that the performance of the model was improved when no padding and Lasso filtering were applied, with a statistically significant difference (P<0.05) . Using the test set data for 216 machine learning models, the best model had an AUC of 0.790 9, accuracy of 75.90%, precision of 75.00%, recall of 78.57%, and F1 value of 0.767 4. The sample size validation results suggested that the study sample size can meet the modeling needs.

In this study, a risk warning model for severe airflow limitation in COPD patients was developed and evaluated. mMRC class, age, BMI, CAT score, presence of smoking history and dyspnea were the key indicators affecting airflow limitation. The model has good predictive effect and has potential clinical application.

Evidence-based Medicine

Meta-analysis and Trial Sequential Analysis of the Effects of Bilevel Positive Pressure Ventilation in the Acute Exacerbation of Chronic Obstructive Pulmonary Disease Complicated with TypeⅡ Respiratory Failure

TENG Wenzhe, CHEN Hu, SHI Siyao, CHENG Kangyao, WANG Yin

2022, 25(02):  227-235.  DOI: 10.12114/j.issn.1007-9572.2021.01.224

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Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) have a significantly increased risk of developing type Ⅱ respiratory failure. In clinical treatment, BiPAP is widely used in this kind of patients to correct respiratory acidosis and delay the deterioration of lung function, but the therapeutic effect of BiPAP in this kind of patients is still controversial.

To systematically review the effect of BiPAP intervention on the treatment of patients with AECOPD complicated with type Ⅱrespiratory failure.

CNKI, Wanfang Database, CQVIP, CBM, PubMed, The Cochrane Library, Springer, Medline, and Web of Science were retrived by computer for the RCTs published from inception to October 2020 regarding the application of BiPAP in patients with AECOPD complicated with type Ⅱ respiratory failure. Two researchers independently screened the retrieved documents, extracted data and evaluated the quality. The first author, country, population characteristics, age, sample size, intervention methods of the experimental group and control group, frequency and duration of intervention of the experimental group, outcome indicators〔pH, partial pressure of carbon dioxide (PaCO₂) , partial pressure of oxygen (PaO₂) , respiratory frequency (RR) , tracheal intubation rate, incidence of adverse reactions〕 and other information were extracted. The Review Manager 5.4 software was used to conduct a meta-analysis of the included literature, and the TSA v0.9 developed by the Copenhagen Clinical Trial Center was used to complete the trial sequential analysis.

A total of 10 RCTs were included, of which 4 were of high quality and 6 were of medium quality. The experimental group could improve the pH value of patients with acute COPD and type Ⅱ respiratory failure 〔MD=0.04, 95%CI (0.03, 0.04) , P<0.05〕, PaCO₂〔MD=-7.22, 95%CI (-8.20, -6.24) , P<0.05〕, PaO₂〔MD=6.23, 95%CI (5.31, 7.14) , P<0.05〕, could improve the RR of patients with acute COPD onset and type Ⅱ respiratory failure within 24 h and after 24 h of intervention 〔MD=-3.85, 95%CI (-4.36, -3.35) , P<0.05〕, tracheal intubation rate〔RR=0.50, 95%CI (0.32, 0.78) , P<0.05〕 are better than the control group. The incidence of abdominal distension〔RR=5.95, 95%CI (1.79, 19.77) , P<0.05〕, facial skin damage〔RR=8.04, 95%CI (1.92, 33.76) , P<0.05〕are higher than the control group. The results of trial sequential analysis showed that BiPAP treatment could significantly improve the outcomes of pH, PaCO₂, PaO₂, RR and intubation rate in patients with typeⅡ respiratory failure due to acute exacerbation of COPD.

BiPAP therapy in patients with type Ⅱ respiratory failure due to acute exacerbation of COPD can improve patients' conditions of respiratory acidosis and hypoxia, and reduce intubation rate. However, BiPAP treatment may increase the incidence of adverse reactions such as abdominal distension and facial skin damage.

Efficacy and Safety Combined with Conventional and Western Medicine Treatments on Coronary Heart Disease Complicated with Heart Failure：a Systematic Review

WANG Tianyuan, WANG Yanbo, FENG Shuo, HU Jing, ZHANG Huina, WANG Hong, LI Bo

2022, 25(02):  236-242.  DOI: 10.12114/j.issn.1007-9572.2021.01.402

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Anti-atherosclerotic and anti-heart failure therapies are the key to the treatment of coronary heart disease (CHD) , a common cardiovascular disease. At present, there are few comprehensive evaluation and analysis on the efficacy and safety of Sofren Injection (SI) in the treatment of coronary heart disease complicated with heart failure.

To systematically evaluate the efficacy and safety of SI combined with conventional and western treatment in the treatment of heart failure in complicated with CHD.

PubMed, The Cochrane Library, EMBase, CNKI, CQVIP, SinoMed, Wanfang Data and other databases were searched from inception to June 7, 2020 . Randomized controlled trials (RCTs) of the application of SI in heart failure with CHD were screened and grouped, SI combined with conventional and western treatment as the experimental group, conventional and western treatment as the control group. Primary outcome indicators included left ventricular ejection fraction (LVEF) , left ventricular end-diastolic diameter (LVEDD) , left ventricular end-systolic diameter (LVESD) , left atrial end-diastolic diameter (LAEDD) , serum carbon monoxide (CO) , and NT-pro-brain natriuretic peptide (NT-proBNP) . Secondary outcome indicators included endothelin-1 (ET-1) , serum nitric oxide (NO) , overall clinical response rate, and incidence of adverse reactions. The Cochrane risk bias assessment tool was used to evaluate the quality of the included studies, and the RevMan 5.3 software was used for meta-analysis.

Eight documents meeting the criteria and 1 075 patients were included. Meta-analysis indicated that the experimental group was superior to the control group in improving heart function index: LVEF〔MD=-8.63, 95%CI (-12.33, -4.93) , P<0.05〕; LVEDD〔MD=5.71, 95%CI (4.82, 6.61) , P<0.05〕; LAEDD〔MD=6.62, 95%CI (5.36, 7.88) , P<0.05〕; LVESD〔MD=3.15, 95%CI (1.84, 4.46) , P<0.05〕; CO〔MD=-0.44, 95%CI (-0.62, -0.25) , P<0.05〕. The experimental group also had better effects on improving NT-proBNP 〔SMD=2.87, 95%CI (1.77, 3.97) , P<0.05〕. Moreover, the experimental group improved endothelial function index of ET-1〔MD=28.32, 95%CI (23.95, 32.68) , P<0.05〕, and NO〔MD=-16.74, 95%CI (-20.13, -13.35) , P<0.05〕 more significantly. The total clinical effective rate of the experimental group was better than that of the control group 〔RR=1.25, 95%CI (1.18, 1.32) , P<0.05〕.

The clinical efficacy of the experimental group on coronary heart disease combined with heart failure is better than that of the control group, which can improve heart function, heart failure markers, endothelial function indicators with good safety. However, the number of existing clinical studies is small and the quality is low, and more high-quality clinical studies are still needed for verification.

Latest Developments

Recent Advances in the Pathogenesis of Glucolipid Metabolism Disorder in Obstructive Sleep Apnea-hypopnea Syndrome

WANG Yun, HE Yan, LIU Shijie, GAN Lulu, GAO Huifang, LIANG Min, ZUO Zhiheng, YANG Li

2022, 25(02):  243-247.  DOI: 10.12114/j.issn.1007-9572.2021.01.311

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Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a disease marked by apnea, hypopnea, decreased oxygen saturation, and disordered sleep structure, which is a major risk for cardiovascular disease. Recent studies have found that OSAHS patients have an increased risk of hypertension, coronary atherosclerotic heart disease, insulin resistance, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, etc. And these patients have a high prevalence of obvious glucolipid metabolism disorder (GMD) , which plays an important role in cardiovascular morbidity and mortality in OSAHS. We reviewed the latest advances in the association of GMD and OSAHS, and the potential pathogenesis of OSAHS-induced GMD and insulin resistance, aiming at providing new ideas for clinical treatment of GMD in OSAHS.

Role of Light Therapy in Circadian Rhythm Sleep-wake Disorders

CHEN Feng, FAN Mei, XIANG Ting, PAN Jiyang

2022, 25(02):  248-253.  DOI: 10.12114/j.issn.1007-9572.2021.01.030

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Circadian rhythm sleep-wake disorder (CRSWD) affects people's health and well-being.Current treatments mainly include exogenous melatonin therapy and light therapy, among which light therapy plays an important role in the treatment of CRSWDas a non-drug treatment.We conducted a review on recent studies about CRSWD, covering the pathogenesis of CRSWD, principle and efficacy of light therapy in CRSWD, aiming to offer new ideas for clinical treatment of CRSWD.

Research Progress of Machine Learning in Clinical Drug Therapy

WU Xingwei, LIU Xinyu, LONG Enwu, TONG Rongsheng

2022, 25(02):  254-258.  DOI: 10.12114/j.issn.1007-9572.2021.01.309

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With the advancement and development of concepts such as real-world research and precision treatment, the demand of researchers for medical big data processing keeps increasing. Because machine learning technology has unique advantages in processing massive, high-dimensional data and conducting predictive research, it has been deeply applied in the medical field in recent years. In addition to the application in disease diagnosis, image recognition and risk prediction, more and more studies have proved that machine learning can be applied to the decision support related research of clinical drug treatment. This article reviews the research progress of machine learning in clinical drug therapy.